Healthcare Provider Details

I. General information

NPI: 1760917728
Provider Name (Legal Business Name): BEATRIZ BAEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4836 LIGUSTROM WAY
ORLANDO FL
32839
US

IV. Provider business mailing address

4836 LIGUSTROM WAY
ORLANDO FL
32839
US

V. Phone/Fax

Practice location:
  • Phone: 407-591-2616
  • Fax:
Mailing address:
  • Phone: 407-591-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: